Services Offered

The Government believes that strong and stable families are the bedrock of a strong and stable society.Health Visitor Implementation Plan 2011-2015

The start of a child’s life is especially important to lay the foundations of good health and wellbeing in later years. The period from from prenatal development to age three is associated with rapid cognitive language, social, emotional and motor development. A child’s early experience and environment influence their brain development during these early years. Warm, positive parenting helps create a strong foundation for the future. New evidence about neurological development and child development highlights just how important prenatal development and the first months and years of life are for every child’s future.

A ‘Netmums’ survey (March 2011) concluded that many new mothers are bombarded with contradictory and sometimes even dangerous parenting advice by family members. Two in five of the 4,000 mothers surveyed said a relative had given advice they felt could harm their baby’s health - Mother-in-laws topped the list of people who had given poor advice! The National Childbirth Trust said it recognised the valuable source of support that family members can offer, but encouraged parents to check the information is up to date by contacting a HV or GP.

Jill’s latest article, published in The Journal of Health Visiting, July 2014, describes the framework of the Family Courts and leads the health visitor through the court process for local authority applications.Family Court appearances may start to become more frequent for health visitors, and this article sets out a helpful and practical guide based on Jill’s many years of health visiting and family court experience. Jill is currently developing training courses for any health visitor who may find themselves appearing as a professional witness in the Family Court.

Ante Natal Assessments

The Department of Health (2009) Healthy Child Programme: Pregnancy and the first five years of life, recommends an antenatal assessment of family and child needs.

Once you’ve had your pregnancy confirmed by your GP you will probably be anxious to meet your midwife. The aim will be for you to receive continuing care throughout your pregnancy from just one midwife. The reality is this will probably not happen.

Depending on how long you intend to work (if you are employed) will determine when you may wish to receive your first home visit from your independent HV. Usually this will be between 28-36 weeks of pregnancy. This first visit will last approximately 1 hour during which you will be asked to share some personal and medical details relating to yourself and partner. Potential areas of discussion will include:

How you may want to feed your baby and the possible impact of your feeding choice may have on you and your baby’s health and wellbeing.

The opportunity for you and your partner to discuss any anxieties or concerns you may have relating to your pregnancy, birth and early days of parenthood.

This visit also gives you and your partner a chance to get to know your HV prior to your baby being born. The cost of this assessment visit will also include any telephone calls and emails for the duration of the pregnancy.

If you prefer, this visit can be arranged in your home or venue of your choice as a group (max 6 couples).

Just Home from Hospital

First Day Home from Hospital

This visit is specifically designed for parents who feel they may need more support than their midwife can offer. You may wish to have the visit anytime within the first 48 hours of your discharge from hospital, but the timing will be entirely up to you. The most common reason for this visit is for support with feeding. You may have decided to breast feed your baby so positioning and attachment will be an important factor at this stage. However, you may decide that for your own personal reasons that you will feel more comfortable with formula feeding. If this is the case, you will be shown how to safely make up and store formula milk feeds plus advice regarding the importance of sterilisation.Other features include a demonstration of how to bath your baby, and general tips on settling a newborn.It is recommended that this visit should last at least 3 hours but depending on your needs this can be increased accordingly.The price of this package includes telephone calls and emails for 1 week post visit (within the stated hours as detailed in terms and conditions).

Post Natal Packages

Post Natal Packages

A Post Natal package consists of 6 weekly visits from when your baby is two weeks old until their eighth week. Each visit will be at least one hour long. The length of the first visit will depend on whether you have already met your private HV during the ante-natal period.

Potential areas of discussion during the New Birth Visit include:• The mother’s health including details of the labour and delivery• Partner’s health including adaptation to becoming a parent• Siblings - if you already have older children• The baby – if your baby is awake, they can be weighed and a top-to-toe check completed which will include recording head circumference. You will be asked how the feeding is going and deal with any concerns you may have. The immunisation schedule will be outlined and you will be given any leaflets you may wish to read about the subject. As with all visits, details of the visit will be recorded in your baby’s red Personal Child Health Record which your NHS health visitor should have already given to you.

Post Natal follow-up visits will be performed weekly until the eighth week.

Included in the cost of this package are telephone calls (within the stated hours as detailed in terms and conditions) and emails that you may wish to make to your health visitor during the 6 week period.

Parents

Parents

Each time you are seen your HV will concentrate a great deal on you and your partner’s health. She will be concerned to know how both of you are feeling and how you are coping with adapting to parenthood. At the eight week visit, you (mother) will be asked if you would like to complete a questionnaire about how you are feeling emotionally. This questionnaire is called the Edinburgh Post Natal Scale (EPNS) and can give an early indication of any post natal depression. Historically, this questionnaire has only been offered to the mothers, but recent evidence suggests that depression after a baby is born can affect both parents. If your partner would like to complete their own questionnaire, let your HV know so this can be arranged.

Infant

Infant

Each time your HV sees you, she may suggest your baby is weighed. At the eight week visit she will also suggest measuring their head circumference and length. All babies and children are weighed without any clothes or nappy on. Weights are recorded in kilograms but can easily be converted to pounds and ounces. Every weight will be recorded on a UK-WHO growth chart which is contained within your child’s Personal Child Health Record (PCHR).

Breastfeeding

Breastfeeding

The World Health Organisation (WHO) recommendation (January 2011) for mothers worldwide is to exclusively breastfeed infants for the child’s first 6 months in order to achieve optimal growth development and health. This is supported by the UNICEF Baby Friendly Initiative.

According to the latest infant feeding survey published in June 2011, the proportion of new mothers who start breast feeding their babies has risen in the past five years from 76%t to 81% across the UK. Four fifths of new mothers plan to breastfeed. However, there has been a steep drop in the numbers continuing to breast feed. Every year more than 200,000 mothers stop breastfeeding in the first few days and weeks. 90% of these mothers would have liked to continue. Previous surveys have found that mothers had to stop breastfeeding before they wanted to because they did not get the help and support they needed.

Breast feeding is not always easy especially if you have experienced a long labour and difficult delivery. Exhaustion, sore nipples and painful breasts can easily deter you from continuing with breast feeding.

HV’s have had extensive training and experience with supporting and advising on all aspects of breast feeding. Support may include positioning and attachment plus tips on signs that your baby is feeding well and giving you the confidence to know that your baby is getting enough milk. There are many other top tips that can be shared as to support you with your decision to breast feed.

Please telephone for more information and to arrange a home consultation.

Unsettled baby

Coping with a crying, colicky or unsettled baby

Regardless of how you have decided to feed your baby, there will be periods when they will cry and be generally unsettled. Looking after a crying baby can be a distressing experience for any parent. Rest assured that you are not alone! Because parents often seek professional help for a crying baby, one estimate says that the cost to the NHS is £65m per year!

Health visitors are truly experienced with supporting parents at this challenging time.

Emotional Wellbeing

Emotional Wellbeing

Being a parent can be overwhelming at times. Research from the Medical Research Council and University College London (UCL) found that one in seven mothers and one in twenty eight fathers experienced depression in their child’s first year. This can be due to exhaustion, grappling with new skills, plus the adjustment of moving from being a couple to becoming parents can test the most solid of relationships.

Although having a baby is a joyous milestone in your life, yet no matter how happy you are, the exhaustion and responsibility of caring for a newborn can play havoc with your relationship. The good news is that conflicts can usually be resolved. As your confidence in parenting grows, relationship stress will fade.

If you feel you are struggling emotionally and not sure where to turn to, your HV has the professional skills to help you through this difficult time.

Each HV visit will be the minimum of one hour, or longer if you so wish. If you have completed the Edinburgh Post Natal Scale (EPNS) and have scored more than 13, this may indicate you are suffering from post natal depression. Your HV may decide it would be useful to repeat the test after 2 weeks.

Depending on how you are feeling and or how you scored with the EPNS, will depend on how many visits you and your HV decide will be beneficial. Research has shown that most mothers benefit from 6 listening visits before a review.

If it is assessed that you are depressed, with your permission, your GP and NHS health visitor will be informed. If necessary, you can be referred to more specialised counsellors.

This package also includes the cost of telephone calls and emails (see terms and conditions). The number of visits required will be determined at the initial visit.

Weaning

Weaning

In 2001 the World Health Organisation (WHO) announced that exclusive breastfeeding for the first six months was best for babies. In 2003, the UK adopted the recommendation. During the early part of 2011, scientists advocated rewriting the rulebook to drop these guidelines. This has outraged breastfeeding campaigners, and has caused utter confusion for parents with small children.

In reality, very few mothers in the UK manage to stick to six months of breast feeding with a baby who by then is taking an interest in the contents of people’s plates. It is estimated that only about 20% breastfeed at all at six months (source Mary Fewtrell from the childhood nutrition research centre at UCL Institute of Child Health)

According to this latest evidence, failing to start weaning on to solid food before six months suggests the baby may have a greater chance of iron deficiency anaemia, and a higher incidence of food allergies. The third potential issue is celiac disease.

Most Health Visitors support the WHO recommendation, but argue that it needs to be interpreted differently in different countries. For example, exclusive breast feeding protects against infections, which is critical in developing countries, but less important in the UK where hygiene and sanitation are better.

Generally, all Health Visitors agree that in no circumstances should weaning commence prior to the 17th week and no later than the 26th week of your baby’s age.

If, like many parents you remain confused or would like more support with any aspect of weaning then call to arrange a home consultation.

Developmental Reviews

Developmental Reviews

During 2009, the Department of Health produced a document entitled “The Healthy Child Programme” which recommended that all babies between 9 months and one year should have their physical, emotional and social needs in the context of their family assessed. A further review is also recommended between two to two-and-a-half-years.

Priority topics which will be discussed at the two year review will be your child’s :

Both reviews give parents the opportunity to talk about any concerns you may have about your child’s health.

Each review will take approximately an hour plus some further time discussing parental health.

It is recognised that the world is changing ; 57% of mothers of under-fives are at work; 40% of two year olds are in early year settings. If this applies to you and taking time off work is difficult, then with parental consent, your child’s review can be carried out wherever they may be whilst you are working. A written report can then be compiled and sent to you, offering you the chance to discuss any concerns when it’s more convenient for you.

Behaviour

Behaviour

Increasingly as your child grows older their behaviour can often become increasingly challenging as they try to push boundaries. This is very normal, but most parents find at some point it can often become overwhelming. If you are struggling with your child’s behaviour and would like professional support and expert advice please call to arrange a consultation. The most common parental concerns generally are sleep, fussy eaters, toilet training, temper tantrums, and challenging behaviour.

Some parent’s concerns will occasionally be more worrying about their child’s behaviour for which they may feel further investigations may be required. Speech delay and concerns regarding your child’s hearing are the most common need for referral to another agency e.g. speech and language therapist for which a small administrative fee will be charged.

Sleep

Sleep Consultancy

Sleep, or the lack of it, is probably one of the most commonly talked about subjects amongst parents with young children.

When you first become a parent you are often told to expect sleepless nights with your newborn baby. What happens if your baby continues to regularly wake at night well past their 6 month birthday? Perhaps your perfect toddler during the day takes on the qualities of a devil at bedtime?

Children need to have the ability to fall, and stay asleep on their own. If your child is older than 6 months and continues to be very unsettled at bedtime or during the night, contact Jill who will be able to offer you a tailor made approach to have your baby or child sleeping normally again within 4-6 weeks.

Some of the most common sleep problems young children may experience include:

Poor bedtime routine leading to bedtime battles

Keep coming downstairs after being tucked in

Falling asleep whilst being fed

Regularly waking for night feeds

Will only go to sleep if certain conditions are met such as rocking, falling asleep on the sofa, or in your bed.

Constantly waking in the night and calling out

Staying awake for long periods during the night

Regularly geting into the parental bed at night

Early rising – waking up very early several times a week

Why sleep is so important.

Sleep is important for all of us as it enables us to optimise our physical and mental performance.

Without sleep we can soon become anxious, which in some cases this can lead to depression.

Less anxiety will help you function better at home and work. Relationships with your partner and children will improve.

More sleep means a brighter and happier child with improved behaviour.

Your child will become more mentally alert.

A consistently good sleep pattern will also boost your child’s immune system whilst at the same time aid their psychological and physical development.

Jill will then send a sleep diary for you to fill in. When you have completed the dairy, a home visit, or telephone consultation will be arranged to complete a detailed questionnaire. Once these steps have been completed, both documents will be reviewed. Jill will then follow up by either a further home visit, telephone or email consultation to discuss your individual sleep programme to restore a regular sleep routine.

During the first week you will either receive telephone or email support. The choice will be yours. A second consultation will then be offered either at home or by telephone 1-2 weeks later. This will depend on progress so far. If required a further review consultation can also be offered. You will also be able to telephone or email Jill for advice anytime between 8am until 10pm for the duration of the package which is usually a maximum of 6 weeks.

Home visits can only be offered if you live within 20 miles of central Norwich. If do not live within this area, then consultations can easily be carried out either by telephone or email, making expert sleep consultations available to anyone wherever you live.

Autism in Toddlers

Autism in Toddlers

Autism, a severe disorder of development, is difficult to detect in very young children. However, children who receive early intervention have improved long term prognosis. If you have such concerns about your child, an initial assessment can be performed. Depending on the results of this will indicate whether a further assessment and paediatric referral are required. Please ring to discuss your concerns so a home consultation can be arranged.

Child Health Clinics

Child Health Clinics

Clinics can be provided to take place in your own home for you and a group of friends. Alternatively, you may wish for a clinic to be held at a mother and baby group setting. Provision will be made for all babies to be weighed with the recommended Class III clinical electronic scales in metric setting. All children up to 2 years will need to be weighed without clothes or nappy. Length or height can be measured whenever there are any worries about your child’s weight gain, growth or general health.

Any concerns you may have about your baby can also discussed at any clinic setting.

Email & Telephone Packages

Email & Telephone Packages

Occasionally, personal contact from your HV may not be convenient for various reasons. You may have to work long hours, or you have moved abroad where support from family and health professionals may either be unobtainable or expensive. If this is the case, an email package may be suitable. Many fathers also prefer this option so they can read about what’s going on. Alternatively you may prefer to speak to your HV by telephone. Whatever your choice, telephone or email to discuss the support you require and your preferred contact method.